Dismissing and preoccupied insecure attachment and procedures in CAT: Some implications for CAT practice

Following a review of the current relationship between the theory of cognitive analytic therapy (CAT) and attachment theory, this paper describes how attachment concepts can be applied in routine CAT practice with neurotic and mild personality disordered presentations. In particular, insecure dismissing and insecure preoccupied patients are likely to manifest different maladaptive procedures, express anger in distinct ways, and use different narrative styles to express their distress. Their varying abilities to collaborate with the therapist are reviewed and implications for therapy are described. Some consideration is also given to how the therapist can provide a ‘secure base’ for the patient within a time‐limited therapy such as CAT.